The ability of children with special health care needs to access dental care is an understudied area. Access to dental and orthodontic care for children with craniofacial disorders is of particular importance since these children require dental and orthodontic care as a direct result of their medical condition and as an essential part of their reconstructive treatment. The overall objectives of this study are to develop tools to characterize barriers to accessing dental and orthodontic care for patients with craniofacial disorders and to identify potential strategies by which access to care may be improved. With that in mind, four specific aims are proposed. In the first project, instruments will be developed, using information obtained from key informant interviews of patients and families, to identify and characterize barriers to accessing timely and appropriate dental and orthodontic care for children with craniofacial disorders. In the second project, Washington state Medicaid claims data will be analyzed to characterize dental and orthodontic care utilization and travel distance for care for low-income children with cleft lip and/or palate. Areas of Washington State where Medicaid beneficiaries with craniofacial disorders have difficulty accessing local dental/orthodontic care will be identified. In the third project, a statewide survey will be developed to assess current level of involvement of community orthodontists in caring for children with craniofacial disorders and to identify factors that could potentially promote or impede increased participation in the future. In the final project, models of patient advocacy programs will be identified and collaborations between the Law School and the Craniofacial Center will be developed with the goal of developing an advocacy program aimed at improving access to dental and orthodontic care for children with craniofacial disorders. At the completion of this planning grant period, we will be prepared to implement a large scale assessment to characterize barriers to accessing dental and orthodontic care and their consequences, as well as intervention projects specifically targeted at the barriers we identify. The overarching goal of the subsequent full-scale project will be to improve access to dental and orthodontic care and thus promote optimal outcomes for all children with craniofacial disorders. This model could potentially be applied to children in other states and to other groups of children with special health care needs.